Dexamethasone suppression test: a review of contemporary confusion

Reasons for the current controversy and confusion about the dexamethasone suppression test (DST) are reviewed, and basic axioms regarding use and interpretation of the test are reiterated. Problems with reliability and validity of current diagnostic systems limit their use as "gold standards" for evaluating the DST; accurate evaluation must await follow-up and treatment response studies. Interpretation of DST results in specific patients requires common sense, consideration of the clinical context, and attention to technical factors. While its ultimate significance is not yet known, the DST, like other laboratory tests, may help to resolve uncertainty in clinical diagnosis. Perhaps most important, it may help to refine current paradigms for psychiatric nosology and diagnosis.